Impact and use of reviews and ‘overviews of reviews’ to inform clinical practice guideline recommendations: protocol for a methods study

Abstract

IntroductionGuidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. High quality and comprehensive systematic reviews and ‘overviews of systematic reviews’ (overviews) represent the best available evidence. Many guideline developers, such as the WHO and the Australian National Health and Medical Research Council, recommend the use of these research syntheses to underpin guideline recommendations. We aim to evaluate the impact and use of systematic reviews with and without pairwise meta-analysis or network meta-analyses (NMAs) and overviews in clinical practice guideline (CPG) recommendations.Methods and analysisCPGs will be retrieved from Turning Research Into Practice and Epistemonikos (2017–2018). The retrieved citations will be sorted randomly and then screened sequentially by two independent reviewers until 50 CPGs have been identified. We will include CPGs that provide at least two explicit recommendations for the management of any clinical condition. We will assess whether reviews or overviews were cited in a recommendation as part of the development process for guidelines. Data extraction will be done independently by two authors and compared. We will assess the risk of bias by examining how each guideline developed clinical recommendations. We will calculate the number and frequency of citations of reviews with or without pairwise meta-analysis, reviews with NMAs and overviews, and whether they were systematically or non-systematically developed. Results will be described, tabulated and categorised based on review type (reviews or overviews). CPGs reporting the use of the Grading of Recommendations, Assessment, Development and Evaluation approach will be compared with those using a different system, and pharmacological versus non-pharmacological CPGs will be compared.Ethics and disseminationNo ethics approval is required. We will present at the Cochrane Colloquium and the Guidelines International Network conference.

Similarities, reliability and gaps in assessing the quality of conduct of systematic reviews using AMSTAR-2 and ROBIS: systematic survey of nutrition reviews

“…With the ever-growing amount of published data, systematic reviews (SRs) and meta-analyses (MAs) became recognised methods for summarising the evidence in support of evidence-based decision-making in healthcare [ 1 – 3 ]. High quality systematic reviews/meta-analyses (SR/MAs) are considered acceptable and important for decision-makers [ 4 , 5 ]. However, with the increasing number of SR/MAs there are often issues of reliability, particularly when SR/MAs have conflicting results and suffer from extensive methodological shortcomings [ 1 , 6 , 7 ].…”

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“…Our methods protocol was previously published in BMJ Open [24], and in the Open Science Framework (https://osf.io/rju4f/). We adhered to guidance for systematic reviews for searching, study selection, data extraction, and critical appraisal [25].…”

“…Our raw data files have been uploaded to the repository Open Science Framework (https://osf.io/8rxnp/ with DOI 10.17605/OSF.IO/ 8RXNP). Our methods are described below and in greater detail in our protocol [24].…”

“…Reporting was inadequate across guidelines, thus limiting our assessment of the methodological quality of the evidence gathering, appraising, and synthesising process. A further limitation is that our study is focused on guidelines for the management or treatment of any clinical condition [24].…”

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“…Using these three evidence synthesis products, developers of guidelines can include only primary studies, both primary studies and systematic reviews, only systematic reviews, and/or both systematic reviews, clinical practice guidelines, health technology assessment (HTAs), or overviews of systematic reviews. This figure was adapted from Lunny et al [24]. https://doi.org/10.1371/journal.pone.0250356.g001…”